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Medical Humanities Companion Volume Three i
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Treatment H
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This third volume in the Companion to Medical Humanities series considers the a Medical Humanities
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concept of treatment as an active process which produces an outcome, be it it
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It invites the reader to examine the relevance of the patients’ belief in any given
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backdrop, it investigates boundaries, and reflects on the practical demands on a o
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be the restriction of service for the other. It also questions the supposed contrasts lu
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between treatment and cure, redefining the meaning of care in daily practice. e
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‘If scientific medicine is grounded in the general, one strong contribution nt
from the humanities is to study the application of that knowledge to concrete
human beings in all their diversity, difference and individuality.’
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Other Radcliffe books of related interest y P Treatment
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MEDICAL HUMANITIES COMPANION VOLUME 1 k
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Symptom L
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Edited by Martyn Evans, Rolf Ahlzen, Iona Heath and Jane Macnaughton h
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MDiEaDgnICoAsiLs HUMANITIES COMPANION VOLUME 2 la, Io
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Edited by Rolf Ahlzen, Martyn Evans, Pekka Louhiala and Raimo Puustinen H
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MEDICAL HUMANITIES COMPANION VOLUME 4 t
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Prognosis , Jo
Edited by Jill Gordon, Jane Macnaughton and Carl Edvard Rudebeck hn
S Edited by Pekka Louhiala, Iona Heath, John Saunders
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ISBN 978-1-84619-370-5
9 781846 193705
www.radcliffepublishing.com
Medical Humanities Companion
VOLUME THREE
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Medical Humanities Companion
VOLUME THREE
Treatment
Edited by
Pekka Louhiala
Iona Heath
and
John Saunders
Radcliffe Publishing
London • New York
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Radcliffe Publishing Ltd
St Mark’s House
Shepherdess Walk
London
N1 7BQ
United Kingdom
www.radcliffehealth.com
Electronic catalogue and worldwide online ordering facility.
” 2014
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted, in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise without the prior permission of the copyright owner.
Pekka Louhiala, Iona Heath and John Saunders have asserted their rights under the
Copyright, Designs and Patents Act, 1998, to be identified as Authors of this Work.
British Library Cataloguing in Publication Data
A catalogue record for this ebook is available from the British Library.
ISBN-13: 978 191022 732 9
Digital conversion by Amnet
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Contents
About the editors and authors vii
Introduction ix
Acknowledgement xi
Playing God (poem by Glenn Colquhoun) xiii
The patients’ stories xv
Anne MacLeod
1 On treatment and its effects 1
Jane Macnaughton
2 Wonderful treatment 17
Martyn Evans
3 Treatment – a matter between subjects 33
Carl Edvard Rudebeck
4 Deciding on treatment 47
Pekka Louhiala
5 Paternalism, power and autonomy 61
Iona Heath
6 Symptoms without disease: territory without a map 75
Jill Gordon
7 The paradox of placebo – real and sham in medicine 85
Raimo Puustinen and Pekka Louhiala
8 Considering the alternatives: or, who is the medicine man? 97
John Saunders
9 Boldness and temperance in treatment 113
Rolf Ahlzén
Index 127
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About the editors and authors
Rolf Ahlzén is a general practitioner and an assistant professor in medical
humanities at Karlstad University in Sweden. He has an academic background
both in the humanities and in medicine, and he is the chairman of the Regional
Ethical Committee.
Martyn Evans joined Durham University in 2002 as Professor of Humanities
in Medicine and Principal of John Snow College, and he became Principal
of Trevelyan College in 2008. He taught philosophy and ethics of medicine
at the University of Wales for several years. He was founding joint editor of
the Medical Humanities edition of the Journal of Medical Ethics from 2000
to 2008. He has published variously on the aesthetics of music, ethics and
philosophy of medicine, and the role of humanities in medical education. His
current interests include music and medicine, the philosophy of wonder and
philosophical problems in medicine. In 2005 he was made an honorary Fellow
of the Royal College of General Practitioners.
Jill Gordon is a general practitioner specialising in psychotherapy in primary
care in Sydney. She is President of the Australian College of Psychological
Medicine and an honorary professor at the University of Sydney where she
initiated Australia’s first postgraduate degree in medical humanities.
Iona Heath worked as a GP in Kentish Town in London from 1975 to 2010.
She was President of the Royal College of General Practitioners, UK, from 2009
to 2012.
Pekka Louhiala is a lecturer in medical ethics at the University of Helsinki,
Finland. He has degrees in both medicine and philosophy, and he also works
as a part-time paediatrician in private practice. He has published on various
vii
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viii ABOUT THE EDITORS AND AUTHORS
topics in medical ethics, philosophy of medicine and epidemiology. His current
academic interests include conceptual and philosophical issues in medicine,
such as evidence-based medicine and placebo effects.
Anne Macleod, poet and novelist, was formerly Associate Specialist
in Dermatology at Aberdeen Royal Infirmary.
Jane Macnaughton is Professor of Medical Humanities and Co-Director of
the Centre for Medical Humanities at Durham University. She is also Deputy
Head of the University’s School of Medicine and Health and teaches on its
undergraduate medical programme. She has published on a wide range
of themes within the medical humanities, including the doctor–patient
relationship, embodied practice, medical education and the role of medical
humanities in critiquing the evidence-base of biomedicine. Having worked as
a GP before moving to full time academic work in Durham, Jane now does part-
time clinical work in gynaecology and is Honorary Consultant in Obstetrics
and Gynaecology at the University Hospital of North Durham.
Raimo Puustinen is a general practitioner with 30 years of clinical experience.
He currently works as an acting professor of General Practice at the University
of Tampere Medical School, Finland. He has published articles and books
on general practice, medical ethics and philosophy of medicine. When not
practising medicine or contemplating theoretical issues in medical practice, he
plays jazz on the tenor saxophone and blues with a blues harp. He is married,
and has four children and six grandchildren.
Carl Edvard Rudebeck is a general practitioner from Västervik in Sweden.
He is a research advisor in the healthcare organisation of Kalmar county,
and part-time professor of general practice at Tromsö University in Norway.
He is involved in various qualitative research projects in general practice and
physiotherapy. He has put much interest into the theoretical aspects of general
practice as a discipline, and into the phenomenology of body experience and
the phenomenology of the doctor–patient interaction.
John Saunders is a consultant physician in Abergavenny, South Wales; honorary
professor at Swansea University; former visiting professor at the University of
Otago, New Zealand; and honorary senior lecturer at Cardiff University. He
was formerly an associate editor of Medical Humanities, chair of the Research
Ethics Committee for Wales; and is current chair of ethics at the Royal College
of Physicians. He recently completed postgraduate studies in philosophy at
University College London.
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Introduction
Symptom leads to diagnosis; diagnosis leads to treatment. That may be
a simple viewpoint for the everyday experience of the average patient.
Treatment is an active process: in treatment, somebody does something.
The outcome may then be related to that something. Of course it may not:
treatment may be ineffective, inappropriate or inadequate. In the first volume
of this series, we emphasised the subjectivities that patients bring to their
symptom experience. Diagnosis, which we explored in the second volume,
turned out to be rather more than the objective process that is so often
presented to practitioners in training. Treatment has always lacked such
objectivities. Entire systems of treatment have competed with one another
over centuries and the triumph of scientific medicine has not been total.
Competing systems continue to make their contribution as alternatives or as
adjuncts. As Thomas points out, ‘If magic is to be defined as the employment
of ineffective techniques to allay anxiety when effective ones are not available,
then we must recognise that no society will ever be free from it.’1 But even
within the box labelled ‘scientific’, there is a great deal more to be said than
the facts of Mr Gradgrind.2 Sometimes patients do better with treatments
that they believe in; sometimes their confidence in the efficacy of a treatment
makes no difference at all. Sometimes treatments are imposed: notably to the
non-autonomous patient, where there is no other option, but also resulting
from the advice of the professional practitioner. Where are these boundaries
to be drawn? How much can be demanded in a healthcare system necessarily
limited in its resources and where the price of choice for one may be the
restriction of service for the other? Added to these practical ethical concerns
are the underlying issues of belief about efficacy, the meaning of treatment
in the patient’s overall life experience, the significance of treatment for those
who have no identifiable malady and the supposed contrasts between caring
and curing.
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